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(Circulation. 2001;104:I-41.)
© 2001 American Heart Association, Inc.

Surgery for Valvular Heart Disease

Anterior Chordal Transection Impairs Not Only Regional Left Ventricular Function But Also Regional Right Ventricular Function in Mitral Regurgitation

Thierry Le Tourneau, MD; Daniel Grandmougin, MD; Claude Foucher, MD; Eugene P. McFadden, MRCPI; Pascal de Groote, MD; Alain Prat, MD; Henri Warembourg, MD; Ghislaine Deklunder, MD, PhD

Service d’Explorations Fonctionnelles Cardio-vasculaires (T.L.T., E.P.M., G.D.) and the Services de Chirurgie Cardio-vasculaire (D.G., A.P., H.W.), Hôpital Cardiologique, the Service de Médecine Nucléaire (C.F.), Hôpital Roger Salengro, and the Service de Cardiologie C (P.d.G.), Hôpital Cardiologique, Centre Hospitalier Régional et Universitaire, Lille, France.

Correspondence to Dr Thierry Le Tourneau, Service d’Explorations Cardio-Vasculaires, Hôpital Cardiologique, CHRU, Boulevard du Pr. J. Leclerc, 59037 Lille Cedex, France. E-mail thletourneau{at}yahoo.fr

Background— Preservation of annuloventricular continuity through the chordae tendinae aims to maintain left ventricular (LV) function and thus improve postoperative prognosis. This study was designed to prospectively investigate the effect of anterior chordal transection on global and regional LV and right ventricular (RV) function in mitral regurgitation (MR).

Methods and Results— Sixty-five patients with severe MR underwent radionuclide angiography before and after either mitral valve (MV) repair (42 patients) or replacement with anterior chordal transection (23 patients). LV and RV ejection fractions (EF) were determined at rest. Both ventricles were divided into 9 regions to analyze regional EF and the effect of anteromedial translation related to surgery. After surgery there was a significant decrease in LVEF (P=0.038) and an increase in RVEF (P=0.036). However, LVEF did not change after MV repair (63.8±9.9% to 62.6±10.3%), whereas RVEF improved (40.7±10.1% to 44.5±8.1%, P=0.027). In contrast, LVEF decreased after MV replacement (61.7±10.1% to 57.2±9.9%, P=0.03), and RVEF was unchanged (40.9±10.9% to 41.3±9.1%). LVEF 4 and 5, in the area of anterior papillary muscle insertion, were impaired after MV replacement compared with MV repair (region 4, 77.6±16.7% versus 87.7±10.8%, P=0.005, and region 5, 73.9±19.3% versus 89.9±13.1%, P<0.001). Moreover, anterior chordal transection led to a significant impairment in the apicoseptal region of the RV (RVEF 4, 50.3±15.6% versus 59.3±13.8%, P=0.02).

Conclusions— Anterior chordal transection during MV replacement for MR impairs not only regional LV function but also regional RV function.

Key Words: mitral valve • surgery • ventricles • myocardial contraction